Indiana - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Indiana, services for individuals with intellectual and developmental disabilities (I/DD) are primarily delivered through the Family Supports Waiver (FSW) and the Community Integration and Habilitation (CIH) Waiver. These programs offer a full continuum of care, ranging from hourly community integration and pre-vocational services to 24/7 residential habilitation and support (RHS). The state does not issue a traditional facility license for waiver homes; instead, agencies must obtain provider approval from the Bureau of Disabilities Services (BDS) and certification from the Office of Medicaid Policy and Planning (OMPP) before enrolling as an Indiana Health Coverage Programs (IHCP) provider.

The single biggest structural barrier to entry for new providers is the 6-month HCBS Waiver Provider Enrollment Moratorium enacted by IHCP effective August 1, 2026. Implemented to mitigate fraud, waste, and abuse, this moratorium strictly blocks new provider enrollments, changes of ownership (CHOWs), and requests from existing agencies to add counties or expand services under the CIH, FSW, PathWays, Health and Wellness, and TBI waivers.

1. Service Definition and Scope

Indiana's I/DD waiver system is designed to help participants gain, retain, or improve self-help, socialization, and adaptive skills necessary to live actively in their communities. The system is split between two primary waivers: the FSW, which provides capped annual services for individuals living with family or independently, and the CIH Waiver, which is reserved for individuals with intensive, 24/7 supported living needs.

Providers can apply to offer specific services within these waivers based on their agency's capacity and accreditation status. All services must comply with the federal HCBS Settings Final Rule, ensuring participants have full access to the greater community.

• Waiver: Family Supports Waiver (FSW) provides capped, non-residential HCBS to individuals of all ages with I/DD.
• Waiver: Community Integration and Habilitation (CIH) Waiver provides comprehensive services, including 24/7 residential support, for individuals with emergency placements or intensive needs.
• Service: Residential Habilitation and Support (RHS) provides up to 24-hour daily living assistance and supervision in a community setting.
• Service: Community Integration focuses on helping participants build socialization and adaptive skills through community-based activities.
• Service: Pre-Vocational Services prepares individuals for paid employment through skill-building and work-readiness training.
• Regulatory Standard: HCBS Settings Rule compliance is mandatory, requiring person-centered planning and community integration for all approved sites.

2. Regulatory and Oversight Agencies

Oversight of I/DD services in Indiana is bifurcated between the programmatic division and the Medicaid authority. Providers must satisfy the programmatic standards of the disability bureau while simultaneously meeting the strict enrollment and billing rules of the state's Medicaid apparatus.

Navigating this dual-agency structure requires interacting with multiple portals and divisions within the state's umbrella health agency.

• Agency: Indiana Family and Social Services Administration (FSSA) [https://www.in.gov/fssa/] serves as the umbrella state health agency overseeing all Medicaid and disability programs.
• Division: Division of Disability and Rehabilitative Services (DDRS) [https://www.in.gov/fssa/ddars/] oversees broad disability program policies and quality monitoring.
• Bureau: Bureau of Disabilities Services (BDS) [https://www.in.gov/fssa/ddars/bds/] manages the day-to-day operations of the I/DD waivers and conducts initial provider approvals.
• Medicaid Authority: Office of Medicaid Policy and Planning (OMPP) [https://www.in.gov/fssa/ompp/] administers Medicaid funding and manages the HCBS Certification Portal.
• Claims Administrator: Indiana Health Coverage Programs (IHCP) [https://www.in.gov/medicaid/providers/] processes Medicaid provider enrollments, fee schedules, and claims.

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana has implemented strict structural preconditions that block applicants before an application is even reviewed. The most critical current barrier is a statewide moratorium that halts all new market entries and expansions for HCBS waiver providers.

Even outside of the moratorium, certain high-acuity services require national accreditation before the state will accept an application, forcing agencies to operate and accredit under different authorities before entering the Indiana CIH waiver space.

• Moratorium: A 6-month HCBS Waiver Provider Enrollment Moratorium (effective August 1, 2026) blocks all new enrollments, CHOWs, and service/county expansions for CIH and FSW waivers.
• Accreditation: CIH Residential Habilitation and Support (hourly) requires the agency to hold national accreditation (e.g., CARF, CQL) prior to BDS approval.
• Entity Type: Applicants must be a legally established business entity registered and in good standing with the Indiana Secretary of State.
• Financial Backing: Agencies must secure and provide proof of general liability and professional liability insurance before submitting the OMPP certification application.
• Exclusion Checks: All owners and managing employees must clear the OIG List of Excluded Individuals/Entities (LEIE) and the Indiana Medicaid exclusion list.

4. Licensure and Certification Requirements

Indiana does not issue a traditional facility license for waiver-based supported living. Instead, agencies must obtain BDS Provider Approval and OMPP HCBS Certification. However, if an agency chooses to operate Supervised Group Living (SGL) homes, they must follow a distinct regulatory track under a different administrative code.

All initial certifications, service additions, and county expansions must be processed through the OMPP Certification Portal. Provider approval is time-limited and must be reverified periodically.

• Rule Citation: 460 IAC 6 governs the provider standards and certification requirements for Supported Living Services and Supports under the waivers.
• Rule Citation: 460 IAC 9 governs the distinct licensure and operational requirements for Supervised Group Living (SGL) facilities.
• Portal: OMPP Certification Portal [https://omppproviders.fssa.in.gov/] is the mandatory entry point for submitting initial provider certifications and policy documents.
• Service Selection: Providers must explicitly select only the services and counties they are qualified to serve; selecting unverified services results in application expiration.
• Reverification: BDS provider approval is time-limited and must be reverified periodically, typically every three to four years depending on the specific waiver cycle.

5. Medicaid Provider Enrollment

After obtaining OMPP Certification, agencies must enroll as billing providers with Indiana Health Coverage Programs (IHCP). This is a distinct, federally mandated step separate from waiver certification.

Enrollment requires navigating risk-based screening criteria, paying federal application fees, and ensuring that both the group entity and all rendering providers are properly linked in the state's Medicaid Management Information System.

• System: IHCP Provider Healthcare Portal [https://portal.indianamedicaid.com/hcp/provider/] is used to submit the Medicaid enrollment application and Schedule A.3 for service locations.
• Application Fee: Institutional providers must pay the federally mandated Medicaid application fee (under 42 CFR 455.460) unless already paid to Medicare or another state.
• Risk Category: HCBS providers are typically categorized as high risk, triggering requirements for fingerprint-based criminal background checks for all owners with 5% or more interest.
• Group Enrollment: For group enrollments, the group entity itself and every rendering provider linked to it must be approved by BDS and enrolled with IHCP.
• Service Locations: A separate Schedule A.3 must be completed for each physical service location being enrolled under the provider's profile.

6. Staffing, Training and Background Checks

Staffing requirements in Indiana diverge significantly depending on whether the agency provides waiver services or operates SGL homes. This structural decision shapes every staffing policy an agency writes.

While waiver services rely on competency-based training, SGL homes have strict annual hour counts. All staff must pass rigorous state and county background checks before having direct contact with participants.

• Background Checks: Requires a limited criminal history check through the Indiana Central Repository and county-level checks prior to hire.
• Waiver Training: Waiver services carry no annual hour count but require competency-based training and an annual in-service covering three state-named topics.
• SGL Training: 460 IAC 9-3-3(c) mandates exactly 24 hours of training per residential staff person per year for Supervised Group Living.
• Certifications: All direct support professionals (DSPs) must hold and maintain current CPR and First Aid certifications.
• Health Screening: Direct support staff must pass TB testing and general health screenings prior to initiating client contact.

7. Documentation, Policies and Records

The OMPP Certification Portal requires a comprehensive upload of operational policies. FSSA strictly enforces document quality; generic templates or blank documents will result in immediate application rejection.

Agencies must tailor every policy to their specific organizational structure, ensuring that the agency name on the documents matches the application exactly.

• Required Document: A comprehensive operational manual tailored specifically to the applying agency's name; generic templates are rejected.
• Policy: Incident Reporting policy that strictly aligns with BDS guidelines for state reporting timelines and participant protections.
• Policy: Participant safety, community activity planning, and emergency response plans tailored to the specific waiver services offered.
• Financial Record: Executed quotes or active policies for General Liability and Professional Liability Insurance.
• Organizational Record: Completed, non-blank organizational charts detailing the agency's hierarchy and management structure.

8. Billing, Rates and Claims

Indiana utilizes a fee-for-service model for its I/DD waivers, with rates published and updated by FSSA. Providers must bill against authorized units specified in the participant's Notice of Action (NOA).

Agencies must also comply with federal Electronic Visit Verification (EVV) mandates for applicable services, integrating their scheduling systems with the state's aggregator to ensure claims are paid.

• Billing Portal: Claims are submitted directly via the IHCP Provider Healthcare Portal or through approved EDI clearinghouses.
• Rate Schedule: FSSA publishes the HCBS Waiver rate schedule, which dictates the maximum allowable billing units and reimbursement rates for CIH and FSW services.
• EVV Mandate: Electronic Visit Verification is mandatory for personal care and respite services under the 21st Century Cures Act.
• Prior Authorization: Services cannot be billed unless they are explicitly authorized on the participant's Notice of Action (NOA) generated by the case manager.
• Claim Format: Professional HCBS claims are typically billed using the CMS-1500 format or the 837P electronic equivalent.

9. Approval Sequence and Timeline

The approval process in Indiana is sequential and strictly gated. Providers cannot move to IHCP Medicaid enrollment until their OMPP certification is fully approved and active.

Timelines are heavily impacted by application completeness and state moratoria. An incomplete application at the OMPP stage will expire, forcing the provider to start the entire process over.

• Step 1: Prepare all required documents according to the OMPP Required Document Definitions prior to opening an application.
• Step 2: Submit the initial certification application and upload all tailored policies through the OMPP Certification Portal.
• Step 3: Await BDS/OMPP review, which can take 60-90 days depending on state volume and active moratoria.
• Step 4: Upon receiving OMPP certification, submit the IHCP Provider Enrollment Application via the IHCP portal.
• Step 5: Complete high-risk fingerprinting and pay the federal application fee within 30 days of IHCP submission.
• Step 6: Finalize waiver program enrollment, receive the IHCP Provider ID, and begin accepting participant authorizations.

10. Common Denials and Survey Findings

FSSA strictly enforces application completeness and accuracy. Most initial denials stem from administrative errors, such as uploading blank documents or failing to secure required accreditations, rather than programmatic deficiencies.

During post-enrollment surveys, agencies frequently face citations for failing to maintain strict training hour counts or lapsing on background check reverifications.

• Denial Reason: Uploading blank documents or generic policy templates that contain a different agency's name.
• Denial Reason: Submitting expired background checks, expired professional licenses, or unexecuted insurance quotes.
• Denial Reason: Selecting services in the OMPP portal (like RHS) without uploading the mandatory national accreditation proof.
• Survey Finding: Failure to maintain and document the strict 24 hours of annual training required for SGL staff under 460 IAC 9.
• Survey Finding: Inadequate documentation of competency-based training and annual in-services for waiver DSPs.
• Survey Finding: Failure to report incidents to BDS within the mandated state timeframes.

11. Key Contacts and Resources

Providers must utilize official state portals and helpdesks for enrollment, certification, and compliance. Relying on outdated manuals or third-party summaries can lead to application rejection.

Bookmark these primary resources to monitor rate changes, policy updates, and the status of enrollment moratoria.

• OMPP Certification Portal: [https://omppproviders.fssa.in.gov/] for initial waiver certification and policy uploads.
• IHCP Provider Healthcare Portal: [https://portal.indianamedicaid.com/hcp/provider/] for Medicaid enrollment, EVV, and claims submission.
• BDS Homepage: [https://www.in.gov/fssa/ddars/bds/] for waiver manuals, incident reporting guidelines, and programmatic updates.
• IHCP Provider Enrollment Page: [https://www.in.gov/medicaid/providers/provider-enrollment/] for application fee details and fingerprinting instructions.
• Indiana Administrative Code (460 IAC): [https://www.in.gov/legislative/iac/] for the legal statutes governing Supported Living and SGL standards.

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